Distributive justice
Distributive justice requires consideration of fairness and the broader
population consequences of a choice, in addition to the impact on the
individual patient. Although the support needed for the initiation of
any inhaler is broadly similar in terms of education and explanation to
ensure appropriate technique, there is likely to be some opportunity
cost to switching inhalers. It may be sensible to build this into annual
reviews rather that attempting to switch a whole population at once.
Avoiding the initiation of these products should of course start
immediately if the takeover goes ahead.
It’s nearly 70 years since Philip Morris vice president George Weissman
announced that if the company had any thought or knowledge that in any
way they were selling a product harmful to consumers, they would stop
business immediately16. Rather than do this, the
tobacco industry have denied the science, aggressively marketed
cigarettes to young people and consistently opposed tobacco control
measures. The attempt by the industry to present itself as promoting
healthcare while simultaneously profiting massively from cigarettes is
obscene. Moreover, although the burden of tobacco production falls most
heavily in poorer countries, profits accrue in the
rich3.
The tobacco industry makes £900 million profit /year on UK sales alone
and has a much higher profit margin (50-70%) than other products such
as food and household goods (typically 12-20%)13.
This represents a substantial market failure, as the industry is only
profitable because it is able to avoid paying for the external costs of
its products - the global societal costs of tobacco are estimated to be
more than $2 Trillion/year17. Rather than engaging in
expansion into the healthcare sector, the tobacco industry must instead
be forced to pay to put right the harm it has caused. The fact that PMI
are in a position to takeover Vectura highlights the need for the
government to take forward the proposed polluter pays levy on tobacco
industry profits18.